Skin tag.. or is it?

CHIEF COMPLAINT: A 68-year-old Hispanic male presented to the clinic for removal of skin tags at both his axillae and around his neck.

CLINICAL HISTORY:

Signs and symptoms: They had been present for a long period of time and they had interfered with his shirt collar and his necklace.

Previous Treatment:

Other information: PMH: He has a history of controlled type II diabetic mellitus, hypertension. He has no personal or family history of skin cancer.
PSH: He had a cholecystectomy at age of 25.
SH: He lived on a farm and had been frequently exposed to sunlight on a daily basis. He admitted occasional alcohol consumption but denied any tobacco used.
ROS: He was Fitzpatrick skin type IV with moderate to severe sun damage. He was overweight.

PHYSICAL EXAM:

There were multiple small soft, skin-colored round and oval pedunculated papillomas with peri-lesional erythema at both axillae and around his neck. Their sizes ranged between 2mm to 7mm at the base. The patient requested to remove the largest lesion secondary to irritation. A shave biopsy was performed.

Multiple Flesh-Colored to Dark Brown Pedunculated Papillomas

Multiple Flesh-Colored to Dark Brown Pedunculated Papillomas

LABORATORY TESTS:

DERMATOHISTOPATHOLOGY:

Microscopic examination of the specimen contained discrete nodular masses of basaloid cells arising at several different sites from the basal cell layer. The tumor demonstrated other features characteristic of basal cell carcinoma, such as uniform cellularity, peripheral palisading, and a distinctive connective tissue stroma.

Solid Islands of Atypical Basaloid Cells with Peripheral Palisading

Presence of Stroma Retraction Artifact and Large Hyperchromatic Nuclei